Provider Demographics
NPI:1710956388
Name:MOORE, LAURA MATTHYS (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MATTHYS
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:MATTHYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6907 BURLINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-525-1846
Mailing Address - Fax:859-647-3355
Practice Address - Street 1:6907 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-525-1846
Practice Address - Fax:859-647-3355
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39716207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64130321Medicaid
KY677405Medicaid
OH0068376Medicaid
KY677405Medicaid
KYK050400Medicare PIN